Provider Demographics
NPI:1225318157
Name:COBB, SELENA JIMMIEKO (CNA)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:JIMMIEKO
Last Name:COBB
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 ANDREW AVILES CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5006
Mailing Address - Country:US
Mailing Address - Phone:813-802-7219
Mailing Address - Fax:813-246-5079
Practice Address - Street 1:1124 ANDREW AVILES CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5006
Practice Address - Country:US
Practice Address - Phone:813-802-7219
Practice Address - Fax:813-246-5079
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL218096376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide